Dealing with insurance after an accident?

[Akimbo]

Assuming or insinuating that someone is trying to do something wrong is where you screw up. You should consider instead that they are trying to find out how to do the right thing...

I didn't take Don's comments like that at all. “Yeah, you're not supposed to make a profit on treatments” sounds like the basic principal rather than an implication.

 

[redacted]

If it were life insurance, they would both pay. If someone has two medical insurers and the are both primary payers with no restrictions, why should they not both pay?

 

[kendallpg]

If it were life insurance, they would both pay. If someone has two medical insurers and the are both primary payers with no restrictions, why should they not both pay?

There is no such thing as a "medical insurer with no restrictions."
Life insurance is a contract that pays an agreed amount when a loss occurs, usually a death, regardless of whether you have other policies in force. It is not the same type of contract as a medical insurance contract.

 

[DandyDon]

Assuming or insinuating that someone is trying to do something wrong is where you screw up. You should consider instead that they are trying to find out how to do the right thing...

I didn't, but then he didn't sound like he wanted to return possible excesses: "Do you have to pay them back the 80% they already paid?" He wasn't asking if he should, but did he have to.

If it were life insurance, they would both pay. If someone has two medical insurers and the are both primary payers with no restrictions, why should they not both pay?

There was a time decades ago, at least in Texas, that one could have private medical policy that was guaranteed renewable, then become covered under a group policy, and in such cases - both paid fully, often yielding profits to the injured & ill. That was not a good situation as it did encourage waste from excessive claims, and I think those have been phased out.

Coverage will indeed on the policy contract details, but I think virtually all will require sharing of payments.

 

[Kevrumbo]

For my treatment in Truk/Honolulu 2008, DAN reimbursed the foreign health care provider Australian Hyperbaric Health (Truk Recompression Chamber); while for the Honolulu follow-up treatment, my primary insurance from work covered all expenses. (DAN also provided for the hotel on Waikiki Beach as I was recovering from my Honolulu Follow-up).

It took a year of email/snail mail correspondence between myself, DAN and their insurance underwriters and Hyperbaric Health Australia before I was finally cut a check from DAN which was then bank wired to Australia. My primary health care insurance from work immediately covered all the expenses from Honolulu (Kuakini Medical Center, Hyperbaric Medicine & Ultrasound Dept, and Queen's Hospital Emergency /CT Radiology Dept) within a month -probably because the services were rendered in the US. . .

 

[h20_kat]

DAN is secondary insurance. Therefore they will pay remaining expenses after a primary insurer has paid what they are required to do by your policy. I don't know if Dive Assure is also secondary but I imagine it is.

Now, if your other insurance is also secondary then they will likely split expenses. This is what happened in my case as my travel insurance was also considered secondary insurance. DAN paid for my chamber treatment immediately and I later received the money for half of the cost of it from my travel insurer and had to send it to DAN.

 

[DandyDon]

DAN is secondary insurance. Therefore they will pay remaining expenses after a primary insurer has paid what they are required to do by your policy. I don't know if Dive Assure is also secondary but I imagine it is.

Now, if your other insurance is also secondary then they will likely split expenses. This is what happened in my case as my travel insurance was also considered secondary insurance. DAN paid for my chamber treatment immediately and I later received the money for half of the cost of it from my travel insurer and had to send it to DAN.

Dive Assure claims to be primary but if you read their conditions, you'll find a clause that says they will share any covered expenses with any other insurer involved. They offer fine coverage but someone thought that spin sounded good and went to far in their claims, in my opinion.

I am surprised that some of the second to pay companies mentioned have paid direct to the claimant who in turn must send any excesses back to the first to pay. I thought they had agreements to work between the insurance companies? I guess it can vary with international transactions.

Edit: Ok, "Subrogation as a matter of law is an equitable doctrine, and forms part of a wider body of law known as unjust enrichment." Results may vary insurance companies tho. Subrogation - Wikipedia, the free encyclopedia

 

[h20_kat]

I am surprised that some of the second to pay companies mentioned have paid direct to the claimant who in turn must send any excesses back to the first to pay. I thought they had agreements to work between the insurance companies? I guess it can vary with international transactions.

In my case my travel insurer is a New Zealand company. DAN settles all claims through the USA. I was a bit surprised that my travel insurer sent the money to me as well! Probably wanted to save themselves the cost of a wire payment.

 

[Keith.M]

Assuming or insinuating that someone is trying to do something wrong is where you screw up. You should consider instead that they are trying to find out how to do the right thing...

I don't think he was assuming or insinuating anything. You are the one who has asked twice about keeping the money.

 

[NAM001]

I would say it is certain that if you have dan then they are not your primary provider adn thus with bummer care you have to have a primary coverage. You will have to provide all your other insurers. for me that would be my blue cross , vetern's ect. Then there is a legal pecking order as to who will pay first. for me its blue cross since it is provided by my employer so they do the first 80% then the Va probably for 80% of the remaining 20% and it goes on. And all this coverage is on allowable charges. So Ill make this up .....CBS does not cove helo trips so you get billed for 20 percent of what BCBS will cover and 100% of the helo. now DAN may cover 80% of the helo and 80 % of insurer non coverable charges. It certainly would be something to talk over with DAN. Good thing is that when you domp on DAN then they may do all the running around to get the moneys. And dont forget about others that have you insured. Like the wife with her employment provided coverage and supliments. She may have you as a dependant to cover things that your provider does not cover.